What Type of Transitional Care Effectively Reduced Mortality and Improved ADL of Stroke Patients? A Meta-Analysis.

Yuncui Wang,Fen Yang,Chongming Yang,Hao Shi,Hui Hu

doi:10.3390/ijerph14050510

Abstract

Stroke is a major cause of disability and mortality worldwide; yet; prior to this study; there had been no sufficient evidence to support the effectiveness of various transitional care interventions (TCI) on the disability and mortality of stroke survivors. This meta-analysis aimed to assess the effectiveness of TCI in reducing mortality and improving the activities of daily life (ADL) of stroke patients. PubMed; Web of Science; OVID; EMBASE; CINAHL; and Sino-Med were searched for articles published before November 2016. Thirty-one randomized controlled trials (RCTs) were identified in the study. This analysis showed that the total effect of TCI on reducing mortality was limited (Risk Ratio (RR) = 0.86; 95% Confidence Interval (CI): 0.75–0.98); that only home-visiting programs could reduce mortality rates (RR = 0.34; 95% CI: 0.17–0.67) compared with usual care; and that the best intervention was led by a multidisciplinary team (MT) ≤3 months (RR = 0.19; 95% CI: 0.05–0.71). In addition; home-visiting programs also produced ADL benefit (RR = 0.56; 95% CI: 0.31–0.81). Overall; there was a statistically significant difference in improving patients’ independence between TCI and usual care (RR = 1.12; 95% CI: 1.02–1.23). However; none of the interventions was effective when they were differentiated in the analysis. It is the conclusion of this study that home-visiting programs; especially those led by MTs; should receive the greatest consideration by healthcare systems or providers for implementing TCI to stroke survivors.

Highlights

Stroke is a major cause of disability and case fatality worldwide, which casts a heavy burden on public healthcare systems in low-income and middle-income countries [1]
Almost 50% of stroke survivors become dependent on caregivers in daily activities [2,3], and the proportion of the years lived with disability (YLDs) to the disability-adjusted life years (DALYs), which is applied to assess the disease burden, which has increased globally from
The results showed that there was no evident publication bias in mortality rate (p = 0.09), activities of daily life (ADL) measured by independence rate (p = 1.00), or Barthel Index (BI)

Summary

Introduction

Stroke is a major cause of disability and case fatality worldwide, which casts a heavy burden on public healthcare systems in low-income and middle-income countries [1]. Immediate admission of a stroke patient to a hospital for treatment and rehabilitation is recommended, while recovery is often left incomplete at discharge. Almost 50% of stroke survivors become dependent on caregivers in daily activities [2,3], and the proportion of the years lived with disability (YLDs) to the disability-adjusted life years (DALYs), which is applied to assess the disease burden, which has increased globally from. London clinical guidelines acknowledge that stroke should be regarded as a long-term condition [5]. Transitional care interventions (TCI) could be assumed to improve stroke patients’ outcomes. Res. Public Health 2017, 14, 510; doi:10.3390/ijerph14050510 www.mdpi.com/journal/ijerph

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Conclusion